Incompleteness and harm avoidance in OCD symptom dimensions

Incompleteness (INC) and harm avoidance (HA) are motivational core dimensions of OCD. While HA-related concepts (e.g., inflated responsibility, overestimation of threat) are a main focus of current cognitive–behavioural OCD research, there is also a renewed interest in INC feelings and “not just right experiences” with an inability to achieve “closure” concerning actions/perceptions. This study systematically examines the association of OCD symptom dimensions with INC and HA in a large clinical OCD sample (n=202). Hierarchical linear multiple regression analyses controlling for anxiety, depression and symptom severity demonstrated a unique association of symmetry/ordering and checking (but not of contamination/washing and obsessional thoughts) with INC, and of obsessional thoughts and checking with HA. Thus, in contrast with symmetry/ordering (predominantly INC-related) and obsessional thoughts (predominantly HA-related), checking was motivationally heterogeneous, i.e., associated with INC and HA to a comparable and substantial degree. Contamination/washing failed to show a unique association with HA in two of three analyses, and with INC in all three analyses. Symptom severity uniquely contributed to INC in two of three analyses, but not to HA. Clinically, our results indicate that a conceptualization of OCD as an anxiety disorder is too narrow.